Peptic Ulcer Disease Education

The road to a cure for ulcers has been a long and bumpy one. Recent news that ulcers are caused by a bacterium and can be cured with antibiotics has changed traditional thinking. Physicians and consumers have not been informed of the good news. Gastric acid was initially blamed for ulcer disease. Therefore antacids and medications that block acid production become the standard of therapy. Despite this treatment, there is a high recurrence of ulcers. In 1982, Australian physicians Robin Warren and Barry Marshall first identified the link between Helicobacter pylori (H. pylori) and ulcers, concluding that the bacterium, not stress or diet, causes ulcers. The medical community was slow to accept their findings. Ulcers are a curable infection, and the fact is that one’s health can be greatly improved and money saved by disseminating information about H. pylori. Whether you think you might have an ulcer, have recently been diagnosed with one, or have been living with ulcers for many years, this brochure brings good news. Recently, scientists have found that most ulcers are caused by an infection. With appropriate antibiotic treatment, your ulcer - and the pain it causes - can be gone forever!

A sizable number of Ghanaians suffer from ulcers. An ulcer is a sore or hole in the lining of the stomach or duodenum (the first part of the small intestine). People of any age can get an ulcer and women are affected just as often as men. Helicobacter pylori (H. pylori) is a bacterium that lives on the lining of the stomach. Although we used to think that spicy food, acid, and stress were the major causes of ulcers, we now know that nine out of ten ulcers are caused by H. pylori. Medicines that reduce stomach acid may make you feel better, but your ulcer may come back. Here's the good news: Since most ulcers are caused by this bacterial infection, they can be cured with the right antibiotics.

The most common ulcer symptom is gnawing or burning pain in the abdomen between the breastbone and the belly button. The pain often occurs when the stomach is empty, between meals and in the early morning hours, but it can occur at any other time. It may last from minutes to hours and may be relieved by eating food or taking antacids. Less common symptoms include nausea, vomiting, or loss of appetite. Sometimes ulcers bleed. If bleeding continues for a long time, it may lead to anemia with weakness and fatigue. If bleeding is heavy, blood may appear in vomit or bowel movements, which may appear dark red or black.

However, there are tests that can be done to determine if your ulcer is caused by H. pylori. A blood test can confirm if you have H. pylori. In addition, an Endoscopy (a small tube with a camera inside is inserted through the mouth and into the stomach to look for ulcers) can be done. During the endoscopy, small samples of the stomach lining can be obtained and tested for H. pylori.

If you have an ulcer, you should be tested for H. pylori, and if found to be infected, you should be treated with antibiotics. Antibiotics are the new cure for ulcers; therapy is 1-2 weeks of one or two antibiotics and a medicine that will reduce the acid in the stomach. This treatment is a dramatic medical advance because eliminating H. pylori with antibiotics means that there is a greater than 90% chance that the ulcer can be cured for good. Remember, it is very important to continue taking all of this medicine until it is gone, even when you begin to feel better. If you are having side effects that make it hard to take your medicine, talk to your health care provider.

Approximately two-thirds of the world's population is infected with H. pylori. It is more prevalent among older adults Africans, and lower socioeconomic groups. H. pylori causes chronic active, chronic persistent, and atrophic gastritis in adults and children. Infection with H. pylori also causes duodenal and gastric ulcers. Infected persons have a 2- to 6-fold increased risk of developing gastric cancer and mucosal-associated-lymphoid-type (MALT) lymphoma compared with their uninfected counterparts.

Treatment regimens used for H. pylori eradication consists of 10 days to 2 weeks of one or two effective antibiotics plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor. Acid suppression by the H2 blocker or proton pump inhibitor in conjunction with the antibiotics helps alleviate ulcer-related symptoms (i.e., abdominal pain, nausea), helps heal gastric mucosal inflammation, and may enhance efficacy of the antibiotics against H. pylori at the gastric mucosal surface.

Antibiotic resistance and patient noncompliance are the two major reasons for treatment failure. Overall, triple therapy regimens have shown better eradication rates than dual therapy. Longer length of treatment (14 days versus 10 days) results in better eradication rates.

So how do people get infected with H. pylori? It is not known how H. pylori is transmitted or why some patients become symptomatic while others do not. The bacteria are most likely spread from person to person through fecal-oral or oral-oral routes. Possible environmental reservoirs include contaminated water sources. Since the source of H. pylori is not yet known, recommendations for avoiding infection have not been made. In general, it is always wise for persons to wash hands thoroughly, to eat food that has been properly prepared, and to drink water from a safe and clean source.

By MH/Dr Ernest Aggrey, 0543999776/[email protected]